ED KASHI

Chronic kidney disease, or CKD, is a scourge of the rich world generally caused by diabetes, high blood pressure, or obesity. An alternative form of CKD however, is finding it’s way into the developing world. Known as chronic kidney disease of undetermined causes, or CKDu, victims are mainly agricultural workers, low wage earners, and rural folk. This growing epidemic is thought to be occupational and environmental, not lifestyle caused, and it’s creating an alarming new medical problem that doctors around the world are barely aware of, have not figured out the cause of, or found a way to prevent it.

In Central America alone, more than 20,000 people have died or contracted this illness over the past two decades. Many similar cases in other countries like India, Sri Lanka, Costa Rica, and more, have highlighted the fact that this is a global epidemic. I recently traveled to southeast India with a team of researchers to the states of Andhra Pradesh and Tamil Nadu, to investigate if this illness is occurring there. Our findings indicated that not only does the illness exist, but also that it may go largely undetected. And often by the time it is diagnosed in a patient, it’s too late. Sufferers of the disease face a shortened life, unable to work or support their families and surviving only on dialysis.

While the Indian government and private doctors, clinics, and hospitals are trying to expand the number and geographic scope of dialysis centers in the affected areas, it’s often inadequate. More troubling is the economic impact and stigma associated with this disease, often rendering a family helpless while trying to keep their loved one, often a man and the breadwinner, alive at all costs. We witnessed their children’s dreams of education dashed with the burdens of paying for dialysis, in turn often forcing them into work to support the family.

This series of images is not only meant to raise awareness, but is also a call to arms for researchers, doctors, and scientists around the world to come together and find the cause, develop cures and find prevention measures for this devastating disease. To combat this global epidemic, action and research is required on a global level.

The accompanying film was originally featured on The Atlantic. Watch it here.

Mahgeswari, the 17 year old daughter of CKDnT patient, Ventkataiah, poses for a portrait outside her family home in the village of Kota.

Mahgeswari, the 17 year old daughter of CKDu patient, Ventkataiah, poses for a portrait outside her family home in the village of Kota.

Ventkataiah, a CKDnT patient, is cared for by his wife at their home.

Ventkataiah, a CKDu patient, is cared for by his wife at their home.

Laborers prepare the Marakannam salt pan fields for salt harvest near Pondicherry.

Laborers prepare the Marakannam salt pan fields for salt harvest near Pondicherry.

Laborers prepare the Marakannam salt pan fields for salt harvest.

Laborers prepare the Marakannam salt pan fields for salt harvest.

Laborers prepare the Marakannam salt pan fields for salt harvest.

Laborers prepare the Marakannam salt pan fields for salt harvest.

Ventkataiah, a CKDnT patient, spends time with his family at home in the village of Kota.

Ventkataiah, a CKDu patient, spends time with his family at home in the village of Kota.

A staff member tends to patients in the dialysis clinic of the Narayama Medical College.

A staff member tends to patients in the dialysis clinic of the Narayama Medical College.

Donna Lakshmi talks with other women and victims of CKDnT. She was widowed less than one year ago after her husband died of CKDnT, chronic kidney disease. And in her village there are more than 126 widows from this disease, out of a total population of 3200 people.

Donna Lakshmi talks with other women and victims of CKDu. She was widowed less than one year ago after her husband died of CKDu, chronic kidney disease of undetermined causes. And in her village there are more than 126 widows from this disease, out of a total population of 3,200 people.

V. Narasaiah, 50, sits at home in his village of Anikepalli. He was a rice farmer for 35 years and then went into hauling before getting sick with CKDnt and now being unable to work.

V. Narasaiah, 50, sits at home in his village of Anikepalli. He was a rice farmer for 35 years and then went into hauling before getting sick with CKDu and now being unable to work.

Agricultural laborers harvest rice in Balliputtuga.

Agricultural laborers harvest rice in Balliputtuga.

Agricultural laborers harvest black whole grain in the village of Uchapalli.

Agricultural laborers harvest black whole grain in the village of Uchapalli.

A young man waits patiently in the hallway of the dialysis unit of the Narayana Medical College.

A young man waits patiently in the hallway of the dialysis unit of the Narayana Medical College.

A patient receives treatment in the dialysis unit of the Narayana Medical College.

A patient receives treatment in the dialysis unit of the Narayana Medical College.

Sravanthi, 25, goes for dialysis in Visakhaptnum. She suffers from CKDnT, and her husband abandoned her and their one year old daughter due to the disease.

Sravanthi, 25, goes for dialysis in Visakhaptnum. She suffers from CKDu, and her husband abandoned her and their one year old daughter due to the disease.

Sravanthi, 25, is photographed with her child and her father at home. She suffers from CKDnT, and her husband abandoned her and their one year old daughter due to the disease.

Sravanthi, 25, is photographed with her child and her father at home. She suffers from CKDu, and her husband abandoned her and their one year old daughter due to the disease.

Sravanthi, 25, cares for her one year old baby at her parents' home in Sompeta.

Sravanthi, 25, cares for her one year old baby at her parents’ home in Sompeta.

A laborer who is sick with Chronic Kidney Disease prepares coconuts for sale in the village of Pedda Srirampuram.

A laborer who is sick with CKDu prepares coconuts for sale in the village of Pedda Srirampuram.

CKDnT positive laborers work on a coconut farm in the village of Pedda Srirampuram.

CKDu positive laborers work on a coconut farm in the village of Pedda Srirampuram.

Ventkataiah, a CKDnT patient, sits for a portrait with his wife and daughter at home in the village of Kota.

Ventkataiah, a CKDu patient, sits for a portrait with his wife and daughter at home in the village of Kota.

Mahgeswari, 17, keeps her father company while studying at home.

Mahgeswari, 17, keeps her father company while studying at home.

Donna Lakshmi, a widow of a CKDnT victim, takes care of her mother-in-law and prepares for work. She was widowed less than one year ago after her husband died of CKDnT, chronic kidney disease. In her village there are more than 126 widows from this disease, out of a total population of 3200 people.

Donna Lakshmi, a widow of a CKDu victim, takes care of her mother-in-law and prepares for work. She was widowed less than one year ago after her husband died of CKDu. In her village there are more than 126 widows from this disease, out of a total population of 3,200 people.

Donna Lakshmi, a widow of a CKDnT victim, poses for a portrait in the village of Balliputtuga.

Donna Lakshmi, a widow of a CKDu victim, poses for a portrait in the village of Balliputtuga.

A widow from CKDnT talks with other widows and sufferers of CKDnT in their village of Balliputtuga, India on Jan. 28, 2016. In her village there are more than 126 widows from this disease, out of a total population of 3200 people.

A widow from CKDu talks with other widows and sufferers of CKDu in their village of Balliputtuga, India on Jan. 28, 2016.
In her village there are more than 126 widows from this disease, out of a total population of 3,200 people.

A mobile CKDnT testing team takes blood and urine samples of patients in the village of Pedda Srirampuram.

A mobile CKDu testing team takes blood and urine samples of patients in the village of Pedda Srirampuram.

Laborers are photographed at the Marakannam salt pan fields near Pondicherry.

Laborers are photographed at the Marakannam salt pan fields near Pondicherry.

Fishermen lay out a net on the beach, with the Indian Ocean behind.

Fishermen lay out a net on the beach, with the Indian Ocean behind.

D. Kesavarao, 49, is photographed near his home. He has stage 5 CKDnT and undergoes dialysis in a town 2 hours away, with his wife Damayanthi, 45.

D. Kesavarao, 49, is photographed near his home. He has stage 5 CKDu and undergoes dialysis in a town 2 hours away, with his wife Damayanthi, 45.

A man sits in a dry rice paddy in Balliputtuga.

A man sits in a dry rice paddy in Balliputtuga.

Part of this work was originally published in Science Magazine on March 31, 2016.